Relapsed or Refractory Mantle Cell Lymphoma: Available and Emerging Therapies
Bibliographic record
Abstract
Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin lymphoma (NHL) that accounts for 5–7% of all NHL. In most cases, it is characterized by t(11;14) leading to cyclin D1 overexpression. MCL displays a heterogeneous clinical behavior, ranging from a very indolent to a very aggressive clinical course. Biological features associated with aggressive disease include morphology (pleomorphic or blastoid), high proliferation index (Ki67 >30%), adverse clinical scores (Mantle Cell Lymphoma International Prognostic Index [MIPIb])3, and TP53 mutation status. Patients who relapse within 24 months of initial treatment (POD24) have a poor prognosis with median overall survival (OS) of approximately 12 months. Most patients achieve long-term disease control with first-line treatment, which currently involves induction rituximab-containing chemotherapy with or without autologous stem cell transplantation, followed by maintenance rituximab. Trials assessing Bruton tyrosine kinase inhibitors (BTKi) and other novel agents in the first-line setting have been recently published or are ongoing. These options are currently not available in Canada outside of clinical trials but may become standard of care in the future. Relapse after first-line therapy is inevitable, and curability outside the context of allogeneic stem cell transplant (alloSCT) remains unclear, with most patients eventually requiring second and subsequent lines of therapy. In the last decade, new therapies have changed the treatment landscape of relapsed/refractory (R/R) MCL, and their optimal sequencing or combination remain unclear. Treatment options will be described herein, with a proposed treatment algorithm for R/R MCL (Figure 1).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".